The Circumcision Decision

by Birth Without Fear on November 27, 2011

I can not thank Lauren, with The Whole Network, enough for doing this very informative and respectful post on circumcision for our BWF readers. It truly is a phenomenal article on such a heated topic. ~Mrs. BWF

During my first pregnancy, I was overwhelmed with joy when I found out that there was a little boy in my belly. Like many ‘mamas-to-be’, I instantly fell in love and spent my days (and nights) dreaming about him. As the months passed by, I began to plan for his arrival: washing and hanging all of his tiny clothes, picking out the softest blankets I could find, figuring out what breast pump would be best. I wanted to be prepared for every little detail. When I began to make plans for the birth itself, I thought about what would happen on the day of his birth, and circumcision crossed my mind.

At the time, I did not think there was even a choice about circumcision. Every male I knew- my husband, dad, brothers, friends – were all circumcised. The thought of a penis with a foreskin wasn’t appealing to me (even though I never saw one in real life), and I had always heard of women saying it was “dirty” or “gross”. I also advocated the benefits of circumcision (even though I never truly looked at the research articles.)

My heart sank in my chest, because I didn’t want to put my new found love through any pain whatsoever. However, after talking to various family members and my OB/GYN, it seemed that circumcision was the best option for my son and his future. “It’s cleaner” and “he’ll have fewer problems” were the most common responses. I had yet to hear a single response that was in favor of not circumcising.

I didn’t think about it much after that, until about 2 months before his due date. By that time, my love for him had grown immensely, and the thought of any painful procedure made my head spin. So one day, I decided to sit down and search on Google to see what came up about circumcision. I was very surprised when the vast majority of the information was against it! My curiosity was perked, and I found myself on YouTube, watching a video of the procedure. After all, my baby boy would have to go through it- so I should see it, right?

My jaw dropped to the floor when I saw the video. I couldn’t stop crying.

From that day forward, I poured everything I could into researching this topic. I wanted to know the truth. Using various sites and forums, I started to network with as many people as I could. To my surprise, I found that there were thousands of parents who had healthy boys who were not circumcised. This intrigued me, because I had always been told that foreskins would cause many problems in boys/men. I needed to know more.

So why was I under the impression that circumcision was best? Why do parents continue to choose it? Why do some doctors advise us to do so? I decided to create a list of the apparent benefits and researched them one by one. I had heard various reasons, such as better hygiene, less chance for UTIs, less chance for HIV/STDs, needing to look like father/brother(s), less chance of penile cancer/HPV, better to be done as an infant and needing to fit in with his peers. Here’s what I found.

Better Hygiene

It’s been said that much more care is needed when boys have a foreskin. That more cleaning time is required, because it is dirty and the foreskin needs to be retracted and cleaned from an early age. However, there is nothing unclean about a foreskin, especially in infancy. In fact, both boys and girls have foreskins, which serve the same purposes. The male foreskin is actually fused to the head (glans) of the penis in infancy and through much of childhood (much like a fingernail is fused to a finger.) This is the body’s way of protecting the genitals against urine and feces. Because it is fused shut, bacteria and other foreign particles cannot invade. There’s no need to retract the foreskin to clean under it. You simply wipe the outside only, like cleaning a finger- it’s easy!

The foreskin will naturally start to separate at an average of age 10. Once he can retract it on his own, he can just simply rinse with warm water in the shower. It’s just as easy as teaching a girl how to bathe and there’s nothing difficult about it.

Information over the internet can only go so far, so I wanted to personally network with people that had intact sons (or were intact themselves). I asked all about hygiene and care, and I never ran into a person or parent that had any issues with it. The parents all agreed that it was easy to care for an intact boy and all of the intact men said it was just a simple rinse in the shower- no extra time or effort. There’s even a video on YouTube that shows how simple it is! You can also listen to a pediatrician on intact care vs. circumcision care.

Less Chance of UTIs

Urinary tract infections are very rare in boys. But the prevalence of UTI in girls up to 2 years is more than twice the prevalence in boys of the same age. The rate in girls up to one year of age is 6.5%, while it is 3.3% in boys. From age one to two, it is 8.1% in girls and only 1.9% in boys. This being said, we can easily treat urinary tract infections in girls with a simple antibiotic, without the need to perform any surgery. In the rare case that a boy might get a UTI, an antibiotic would solve the problem.

There have been some claims of an increased risk of UTI during the first year of life for boys who are not circumcised. According to Psychology Today, “This claim is based on one study that looked at charts of babies born in one hospital (Wiswell 1985). The study had many problems, including that it didn’t accurately count whether or not the babies were circumcised, whether they were premature and thus more susceptible to infection in general, whether they were breastfed (breastfeeding protects against UTI), and if their foreskins had been forcibly retracted (which can introduce harmful bacteria and cause UTI) (Pisacane 1990). There have been many studies since which show either no decrease in UTI with circumcision, or else an increase in UTI from circumcision. Thus circumcision is not recommended to prevent UTI (Thompson 1990).”

Less Chance of HIV/STDs

A few select studies show a prevalence of HIV transmission in uncircumcised men, but real world empirical data shows that circumcision hasn’t stopped HIV in countries where there is already a prevalence of the practice of circumcision. Take the United States for example: we are a country with a very high rate of circumcision (70% of the current male population, compared to 10-15% worldwide), yet we have one of the highest rates of children/adults living with HIV & AIDS out of the post-industrial nations.

Greg Millett of the U.S. Centers for Disease Control and Prevention even said the following: “overall, we found no association between circumcision status and HIV infection status” when he presented his findings to the CDC’s National HIV Prevention Conference.

While circumcision is very common in the United States, it is uncommon in Europe. This would lead one to assume that HIV/AIDS and sexually transmitted diseases would be much higher in Europe, where circumcision is rare. However, this publication clearly shows that HIV and sexually transmitted diseases are much higher in the United States:

“The percentage of the United States’ adult population that has been diagnosed with HIV or AIDS is six times greater than in Germany, three times greater than in the Netherlands, and one-and-a-half times greater than in France.(Fig. 5)[5]”

“…data from the Netherlands found that rates of reported incidence [of sexually transmitted diseases] are considerably higher in the United States.[6,7] Further, comparisons of prevalence (the proportion of a given population which is infected) find that the Chlamydia prevalence among young adults in the United States is twice that among young adults in the Netherlands.[8,9]*”

Less Chance of Penile Cancer/HPV

Penile cancer is among the diseases circumcision claims to prevent. However, it is important to remember that penile cancer is incredibly rare. Did you know that more men are diagnosed and more deaths occur from male breast cancer than penile cancer? The chance of dying from penile cancer is so low that it is not even presented separately by http://www.cancer.gov/ – it is lumped in with all male genital cancers (including testicular cancer and the much more common prostate cancer) at a total of 310 estimated deaths in 2010. Compare this to the annual circumcision death rate of approximately 117 neonates (first month of life). That’s more than SIDS (115 annually) and more than suffocation (44) and auto accidents (8) combined. (via Saving Babies)

The Journal of Infectious Diseases from the Oxford Journals did a study on the baseline prevalence of penile, scrotal, and perineal/perianal human papillomavirus (HPV) in heterosexual men on 5 continents. They found that “Neither condom usage nor circumcision was associated with HPV DNA prevalence.”

“As representatives of the American Cancer Society, we would like to
discourage the American Academy of Pediatrics from promoting routine
circumcision as preventative measure for penile or cervical cancer.
The American Cancer Society does not consider routine circumcision
to be a valid or effective measure to prevent such cancers.

Research suggesting a pattern in the circumcision status of partners
of women with cervical cancer is methodologically flawed, outdated and
has not been taken seriously in the medical community for decades.

Likewise, research claiming a relationship between circumcision and
penile cancer is inconclusive. Penile cancer is an extremely rare
condition, effecting one in 200,000 men in the United States. Penile
cancer rates in countries which do not practice circumcision are lower
than those found in the United States. Fatalities caused by
circumcision accidents may approximate the mortality rate from penile
cancer.

Portraying routine circumcision as an effective means of prevention
distracts the public from the task of avoiding the behaviors proven to
contribute to penile and cervical cancer: especially cigarette smoking
and unprotected sexual relations with multiple partners. Perpetuating
the mistaken belief that circumcision prevents cancer is inappropriate.”

Better to be Done as an Infant

It has often been said that circumcision is better to be performed on an infant for various reasons, but it is important to look at the subject logically. If a man is left intact, he can always choose to be circumcised later. However, once a circumcision is performed, it cannot be undone. There are many cases of men who are unhappy with their circumcision, and wish that they had the choice.

Even if he opted for circumcision later, not only would he have the choice, but he would also get adequate pain medication for the surgery and understand what is happening to his body. A large majority of routine infant circumcisions are not performed with any anesthetic. In fact, up to 96 percent of the babies in the United States and Canada receive no anesthesia when they are circumcised, according to a report from the University of Alberta in Edmonton.

This has many parents (and medical professionals) concerned about the pain associated with circumcision, but is a local anesthetic even enough?

In this research study, 11 male newborns were circumcised with a local dorsal penile nerve block, and 13 controls were circumcised without anesthetic. When the adrenal cortisol levels were compared, response to surgery was not significantly reduced by the administration of lidocaine. Some doctors use EMLA cream as an anesthetic. Not only is EMLA cream less effective than a lidocaine injection, but the manufacturer’s insert warns against its use on infants and on the genitals of children.

The truth of the matter is, infants cannot get the adequate pain treatment, including post-op pain medication, like an adult would. They don’t understand what is happening to their bodies, and most of all, they don’t have a choice.

Needing to Look Like Father/Brothers

This was a very important issue for me. My husband is circumcised, and so is his oldest son. I was worried that there would be issues with the new baby being different than his dad and brother. I didn’t want him to feel different or alone.

I found out that a distant family member was kept intact, even though his older brother and dad were circumcised. Although it seemed like it would be an awkward conversation, I just had to have my husband ask him about it. So he did. It turned out that he really didn’t care and it was never a big deal.

I connected with other men who grew up intact with circumcised dads, and they laughed saying, “I don’t even remember what my dad’s penis looked like…. and quite frankly, I wouldn’t want to remember!”

It all made sense even though I never thought of it that way. To my surprise, it just wasn’t an issue for these men. There were even online groups dedicated to keeping future sons intact, and I spoke with hundreds of parents who had made this same decision. Many of them now had grown children, and were happy to share their experience with me. I asked many questions, and it came down to this: as parents, we can only do what we think is best for our children. But, we also need to be able to grow and learn, so we can always make the best decisions possible. Sometimes, we learn that a past decision wasn’t necessarily the best, and that is OK. We adapt and move on, and our children will understand that. “I did then what I knew how to do. Now that I know better, I do better.” – Maya Angelou

Needing to Fit in with His Peers

“Getting made fun of in the locker room” was a very common response for potential issues for boys who were not circumcised. This was also an important issue for me, much like the issue for my son to look like his father and brother. While this may have been an issue for men in previous generations, it is just not the same for boys growing up today.

In 2010, a slide presented by a CDC researcher at the International Aids Conference in Vienna claimed that circumcision rates in the US had dropped to 32.5% in 2009. While this number was not actually endorsed by the CDC, their 2010 reports still show circumcision rates have dropped over the years (54.7% in 2010). No matter which number you choose to use, the results are the same: circumcision rates are falling in the United States, and continue to do so. With at least half of American parents saying no to circumcision, intact boys will no longer be in the minority. Boys growing up in today’s generation will have the same amount of peers who are intact vs. circumcised.

Some regions in the US have a higher percentage of intact males, while other regions have a lower percentage, so it will vary depending on your location. However, it is important to remember that no matter what, children are going to be different than each other in a variety of ways. Some will be considered too smart, not smart enough, too fat, too thin, too tall, too short… the list goes on and on. The main thing is to be sure to teach our children to understand that they are unique and that they should love themselves for who they are. After all, they are special in their own ways, and that will never change.

Conclusions

Fast forward to now, and my son is happy, healthy and has never had a single problem whatsoever with being intact. As I’ve continued to research the subject, I’ve learned so much more than I could have imagined, such as the many important functions of the foreskin and how specialized it is. It is truly so much more than a “flap of skin”.

I’ve been so moved by the plethora of information I have discovered, that I even founded a grassroots non-profit organization called The WHOLE Network. I wanted to be able to reach other parents who were in the same shoes as I, and make sure they had a place for accurate information and support. As more and more parents seek out information, we continue to grow and help others. We have locations in each US state, as well as various countries worldwide. If anyone ever has any questions or needs information, we would love to help them and get them the accurate information they need.

We know that parents want what is best for their children. We understand that many moms and dads are simply trusting in the advice of their doctors or family. We aren’t here to condemn parents, or to make them feel guilty for past decisions. We are here to empower parents with information, and help inform them so that they can make educated decisions for the ones that they love most.